Dr. Jeffrey K Mckenna
Dermatologist Procedural Dermatology MOHS-Micrographic Surgeon
100 Deerpath
Charleston
, Illinois 61920-9427
Dr. Jeffrey K Mckenna
Dermatologist Procedural Dermatology MOHS-Micrographic Surgeon
100 Deerpath
Charleston
, Illinois 61920-9427
(309) 452-3376
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
- Procedural Dermatology
Languages spoken
- English
Location
First Address
- Dr. Jeffrey K Mckenna
- 3024 E Empire St Second Floor Ste E & F
- Bloomington, IL
- Zip : 61704-5402
- Fax : (309) 452-3376
- Phone : (309) 451-3376
Second Address
- Dr. Jeffrey K Mckenna
- 100 Deerpath
- Charleston, IL
- Zip : 61920-9427
- Fax : (217) 234-8003
- Phone : (217) 234-8000
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207N00000X | Dermatologist | 036-118958 | IL |
| Y | 207ND0101X | MOHS-Micrographic Surgeon | 036.118958 | IL |
| N | 207NS0135X | Procedural Dermatology | 036-118958 | IL |
National Provider Identifier
| NPI | 1396713780 |
|---|---|
| Provider Name | Dr. Jeffrey K Mckenna |
| First Address | Bloomington, IL 61704-5402 |
| Second Address | Charleston, IL 61920-9427 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/03/2006 |
| Last Update Date | 05/08/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.